Eyelid Surgery (Blepharoplasty)

By removing excess skin and bags, eyelid surgery (Blepharoplasty) can improve many of these problems. It cannot, however, totally eradicate all eyelid creases. Doing so would create excess tension on the eyelids and result in an overcorrection. Nor can surgery remove laugh lines at the sides of the eyes or malar bags (bulges high on the cheek bones).

Blepharoplasty has evolved significantly in the last 15 years, and mistakes of the past should stay where they belong i.e. in the past.

In the upper eyelid, attempts to clear very heavy fatty tissue excess has been shown to produce a hollow appearance (doll's eyes), that can make the patient look more tired and is objectionable to most women and men.

In the lower eyelids, a better understanding of the relationship between the cheek, the rim of the orbit and the eyelid bags, has led surgeons to understand that a youthful appearance does not come from purely removing the bags, but rather from a more complex attempt to reduce volume as well as redrape the tissues over the bony edge. The aim is to restore a smoother contour between the lower eyelid than the cheek, reducing as much as possible the appearance of the circles under the eyes. This also allows us to avoid a hollow appearance of the lower eyelids.

Your eyes

Your eyes are your most important facial feature. They are what people notice first when they meet you and the feature they focus on most. The appearance of our eyes plays a large role in how young, attractive and vital we appear.

Heredity is an important factor, especially for young or middle aged people noticing changes usually associated with more advanced aging.

Facial structure can play a role as well. Even slightly under-developed malar and upper jaw bones provide insufficient support to the lower lids. This can lead to lower lid bags and low position of the lid even in younger patients.

Sunlight and ultraviolet rays damage the area around the eye through their direct effect on the skin and by causing us to squint, which builds up muscle thickness below the eyelashes.

Finally, normal aging causes stretching of the eyelid skin and leads to excess folds, wrinkles, and sagging of the fat around the eye which appears as bulges in both the upper and lower lids.

Eyelid Surgery consultation: learning more

At your consultation, your surgeon will ask about your general medical history and any previous eyelid surgery. He or she will also ask about any possible thyroid or kidney disease as these can produce swelling of the eyelids, and about any history of eyelid conditions and dryness of the eyes.

Your surgeon will also point out normal differences in facial symmetry you may never have noticed, and describe the results you can expect from your surgery and the positioning of the scars.

It is very important to highlight to your surgeon the elements that you find most objectionable about the appearance of your eyelids and to try to define what you would like to see as an end result.

Not infrequently, heavy upper eyelids can be significantly corrected using a forehead lift.

Your surgeon will make clear the kind of changes you can expect from each procedure, as well as its inherent limitations.

New techniques allow for elevation and support of the lateral part of the eyebrow through the upper eyelid procedure. This can combine the benefits of a forehead lift and upper lid blepharoplasty in a smaller procedure. At the same time, it is now possible to reduce the frown lines between the eyebrows during an upper eyelid blepharoplasty, by directly accessing the muscles that produce the lines and weakening them.

What to expect from eyelid surgery

Eyelid surgery can be performed with local anaesthetic and sedation or under general anaesthetic. It may be done as a day case procedure or it may be done at the same time as a face lift to enhance the results.

The incision for the upper eye surgery is made in the natural crease line approximately one centimeter above your eyelashes and extends a little into the "crow's foot" area at the side of the eye.

Excess skin is trimmed and any fat in the area at the side of the nose is removed.

In instances where significant fullness is present in the lateral part of the eyelid, a small amount of fatty tissue is also removed from that area.

Subsequently, the lid is sutured using most commonly one continuous stitch.

The incision for the lower lid is made just below the eyelashes, and runs out to the natural "laugh line" area.

Tissues are then elevated and hinged forward and excess fat is partly removed and partly redraped.

During this operation, a light uplift of the cheek fullness will contribute to a more beautiful appearance of the cheek prominence and eyelid complex.

Finally, the skin is lifted upwards and outwards, with no tension, and overlapping skin is removed before the incision is closed.

If excess skin is minimal, it is sometimes possible to perform this lower lid surgery without external scars, a procedure known as transconjuctival blepharoplasty. This allows for contouring of the lower eyelids and circles under the eyes, without leaving external scars. It can be accompanied by resurfacing of the lower eyelid either using chemical peel or laser.

Recovering after eyelid surgery

After your surgery you will be advised to take a number of precautions:

To avoid bleeding, you should not stoop or carry out vigorous activities for five days after your surgery.

Your eyelids should be gently splashed with water but not rubbed in any way.

Antibiotic eye ointment should be applied for three or four days and you should not use eye makeup for the first week or two.

It is important to avoid aspirin after your surgery. Any discomfort around the eyelids may be controlled by mild analgesics such as Paracetamol. You may also find the use of artificial tears helpful in the first few days.

You will not be able to wear contact lenses for some time after your surgery, so you will want to arrange for glasses to use during this time.

It is essential that you have large sunglasses to wear after your surgery.

Your stitches will typically be removed three to seven days after your procedure. Your scars will be pink for some weeks, occasionally months, however they are easily hidden with makeup. Scars in the "crow's feet" area may become lumpy for a while but will invariably flatten in time. This flattening may be helped by gentle massage begun two weeks after your surgery.

Every surgery involves some risks and uncertainties.

Complications after eyelid surgery are rare and most, including excess tears or abnormal pigmentation of the eyelid skin, are temporary.

As with any surgery, bleeding and infection can occur. Bleeding might require a return to the operating theatre to avoid damage to the eye. Infection is usually readily treated with antibiotics, extending the course of treatment that you will have received after your surgery.

Occasionally, what appears to be a transparent sack of fluid develops and covers part of the white of the eye mostly in the outer corner. People who suffer with hay fever may be familiar with this problem as they sometimes notice it during a bad season. While this looks distressing you should not be alarmed as it will settle on its own. During the period when it is settling you need to use eyelid lubricants regularly.

A scratch on the cornea (the surface of the eye itself) while not serious, can be irritating and may take several days to heal.

Your choice

Is cosmetic surgery right for you? As a practice dedicated exclusively to cosmetic surgery and headed
by a highly experienced surgeon, we have the expertise and
understanding to help you answer that question wisely.

This web site is intended to be a helpful starting point. You'll find answers to frequently asked questions, descriptions of the various procedures offered, information about the consulting surgeon who directs the
practice and more. If you have additional questions, please fill in the Contact Form to arrange a private consultation with Mr Lucian Ion.

Aesthetic Plastic Surgery Ltd and Mr Lucian Ion, FRCS (plast) have provided this cosmetic surgery
website for informational purposes only. It is not intended for medical advice. For more information
about cosmetic surgery in London, please contact Mr Lucian Ion for a cosmetic surgery consultation at
our practice located in London, 129 Harley Street.